hi, my name isXXXXX have been diagnosed with Major Depressive

Resolved Question:

hi, my name isXXXXX have been diagnosed with Major Depressive Disorder (severe, recurrent) as b severe Generalized Anxiety Disorder and Panic Disorder since I was 19. I have also been diagnosed with ADD since I was 15. I am now 24, and earlier this year I experienced trauma resulting in a PTSD diagnosis now, too. I had been prescribed to Adderall 20 mg twice daily, Wellbutrin SR 300 mg daily, and Klonopin 1 mg two-three times a day as needed for a few months before the traumatic events. Because of the severity of my already existing panic & depression, my attacks after trauma became so severe that they have caused me to seize, and was placed on Lorazepam 1 mg as needed and one 30 mg Mirtazepine for sleep. I had to move not long ago and started seeing a new psychiatrist who decided to switch me from wellbutrin to Lexapro, and from remeron to Trazadone. he also stopped the lorazepam and placed me on Neurontin 300mg twice daily. during group therapy a couple days later, I blacked out and was rushed to the ER with extremely low blood pressure and heart rate. I was unresponsive and unconscious for 24 hours and when I woke up was asked if I had OD'd. I hadn't at all, and my tests came back completely normal but they sent me to inpatient anyway. the psych at the hospital stopped all meds except the adderall, and placed me on Effexor XR 150mg daily with Seroquel 50mg at bedtime, with vistaril 50mg as needed for anxiety. This is the first time after countless medications and 6 years that I felt normal. However, I've been taking these now for 2 months, and something has changed...my anxiety has come back, my sleep is messed up completely, and even though my depression is under control, I still have no energy or motivation and avoid socialization at all costs....I don't see my Dr again til Dec. and I've been having panic attacks, intrusive thoughts, trouble falling and staying asleep, horrific nightmares causing me to wake up having panic, and I've even experienced some kind of hallucination the last few nights...I don't know what to do, I don't know why my meds have been switched so much this year and I am scared to death about these hallucinations....please help me

I am so sorry that you have experienced these symptoms, I cam imagine how distressing this is for you

Dr. Z :

Can you describe the hallucinations for me please?

Dr. Z :

Like how often they occur and what do they consist of?

Customer:

well the one I had last, I was lying in my bed by myself and then all the sudden there were three other people in my room but they were just black figures

Customer:

and they kept whispering and I kept telling them to leave me alone and that they weren't real

Customer:

and they were dancing around, and then it stopped

Dr. Z :

And do these hallucinations only occur primarily at night or in the day? Or do they occur during the day and at night?

Customer:

the other one was of another dark figure person that was really tall standing by my desk watching me and wanting to kill me

Customer:

these two happen at night, I've had one during the day that was different

Customer:

so I guess mostly at night

Dr. Z :

How was it different during the day though?

Customer:

they've occurred three times now

Customer:

the one in the day I suddenly didn't know where I was because I thought I was somewhere else and didn't know who my friend that was with me was and was calling him by another name and asking about his wife and kids...he doesn't have a wife or kids

Customer:

then he asked me what I was talking about and if I was okay and I was so confused

Customer:

then was back to normal again

Customer:

it was scary

Dr. Z :

Okay so that is actually a sign of dissociation and is not a hallucination. Dissociation are typical of PTSD. Also the hallucinations that happened at night were most likely illusions due to your increased anxiety and nightmares, which is also related to your PTSD. So most likely you do not have a psychotic disorder if that is what you are concerned about.

Customer:

I don't know if that's a hallucination or not but yeah

Dr. Z :

I think increasing the Effexor and Seroquel would be beneficial for you, but also I think that you need therapy preferably Cognitive Behavioral Therapy (CBT) as the medications alone are not as effective unless they are combined with therapy to help you with your symptoms. CBT has a premise that your symptoms are caused by negative thoughts, so if we change your thought process to be more positive and objective as well, then your symptoms will lessen.

Customer:

I didn't think that I did, I know people who suffer from psychotic disorders and I know it isn't the same...but I don't understand why PTSD would give me illusions like and anxiety

Dr. Z :

In addition, for your extremely severe symptoms I would recommend the use of an adjunctive agent called Risperdal, which is an atypical antipsychotic, but it can lessen your symptoms greatly.

Customer:

I have been in CBT since April, including group outpatient as well as inpatient at two hospitals in the last 5 months

Dr. Z :

Okay that is good that you are in CBT. PTSD can cause increased levels of anxiety that disturb your perception where it can cause these illusions and because they happened at night, when it was dark, leads me to believe that your sensory perceptions were already inhibited by it being dark, and that the anxiety led you to believe that these were occurring, but you knew that they were not real. Most individuals with hallucinations especially for the first time think they are really occurring.

Customer:

yeah, I did at first but told myself there was no one there.. but it wasn't dark, I have to sleep with a light and/or TV on

Dr. Z :

Oh it was not dark, then it is possible that they were hallucinations related to your PTSD then. Severe PTSD can cause hallucinations and other possible psychotic symptoms too

Customer:

I do not know why I was taken off klonopin or gabapentin at all, as klonopin is the only thing I've been given that actually helped, and gabapentin seemed to help a lot too...

Dr. Z :

The Klonopin is very addictive and they probably did not want you to get addicted to it, but the Gabapentin is not physically addicting and I am not sure why they took that away.

Dr. Z :

Especially if it was helping.

Customer:

I didn't realize how severe my PTSD actually was until fairly recently either and it is hard to understand

Dr. Z :

It is also possible that the medications are causing these symptoms because you said that it took two months to start experiencing these symptoms and that is the average time for the medications to reach they maximum effectiveness in your body.

Customer:

I have been put on more medications in the past 5-6 years than anyone should be on in their whole lifetime

Customer:

how would the medications cauyse the symptoms though?

Dr. Z :

Well the medications are not particularly strong for anxiety at their doses, and since you are not on any benzodiazepines may cause these hallucinations and increased symptoms of your PTSD because you are not on an effective medication to treat this.

Dr. Z :

The medications can cause it as you may have a bad reaction to the medications, also the mix of Effexor an Adderall can increase your chances of getting something called Serotonin Syndrome, which is very rare, but possible

oh wow it is very possible then. but I have been on everything from Zoloft to lexapro to pristique, and the effexor is the only one that has ever truly helped at all...I also was first on ativan and buspar for the anxiety before the klonopin...and right after my traumatic experiences my doctor admitted me to a psych ward, where they incorrectly diagnosed me with bipolar disorder and had me taking 3 geodons, 3 400mg gabapentins, 3 klomopins as needed, 2 seroquel+ ambien at bedtime which really messed me up too.

Dr. Z :

I am so sorry, well the Effexor can definitely be raised if you would like, but that may mean lowering you Adderall. Adderall can also contribute to anxiety for some individuals.

These were studied by professionals in several studies and they were found to be the most effective

Customer:

yes I know, its an amphetamine but it has never had that effect on me at all. it actually helps my anxiety a bit.

Dr. Z :

Well that is good, I just wanted to mention it as it can increase anxiety for some people

Dr. Z :

Well you can tell your doctor that you have increased symptoms that are most likely related to your PTSD like hallucinations and dissociation and you feel that your current medication regimen is not effective for you

Dr. Z :

Also you are within your rights to ask for another psychiatrist that specializes treating individuals with PTSD.

Customer:

okay. is there anything I can try to do to help until I can actually get in to see him

Customer:

I practice coping skulls regularly

Dr. Z :

Well I do not recommend changing your medication regimen with your doctor's knowledge. If you call or email him, many doctors will give you the okay to increase your medication regimen right away without seeing him and that may relieve your symptoms.

Dr. Z :

This is a link for something called Progressive Muscle Relaxation that can help you create a long term calm by using muscle tension and release techniques; it can help manage your PTSD symptoms and is very similar to a style of meditation.

Well the relaxation exercises are usually just putting a bandaid on the problem and not really a good treatment method. I feel that if you get on the right medication regimen, which as I said may take some trial and error unfortunately, and the right therapy will help you

I also have been having obsessive compulsive type symptoms lately which I'm certain are PTSD related

Dr. Z :

Oh most definitely, that is related to the anxiety element of PTSD. It is very common actually

Customer:

my therapist has been talking to me a bit about edmr. she has also suggested the idea of me going out of state to a facility that is specifically for trauma patients?

Dr. Z :

Well I think you definitely do have a complex version of PTSD with severe symptoms, so going to a specialist facility would be reasonable.

Customer:

can you possibly give me more information about PTSD and mdd and such?

Dr. Z :

Well what would you like to know specifically?

Dr. Z :

PTSD, MDD, and Generalized Anxiety Disorder/Panic Disorder, are very similar and have a lot of overlapping symptoms actually.

Dr. Z :

PTSD actually has a mixture of symptoms from all three disorders of MDD, Generalized Anxiety Disorder, and Panic Disorder

Customer:

yes I did know that, however I suffered from the had/panic and MDD much before

Dr. Z :

I understand that, but I feel that if you treat the PTSD then the symptoms of the other disorders will lessen greatly too as the treatments for them are very similar

Dr. Z :

The only recommendation I would make for the severe MDD since it has not responded well to medication would be Transcranial Magnetic Stimulation (TMS), which is reserved for resistant depressive disorders, but may not be effective for anxiety or PTSD disorders.

I guess that's what I'm trying to ask... I started having panic attacks outta the blue one day and after the first one, they came daily out of nowhere sometimes lasting entire days or coming multiple times a day to the point of crippling me from life so my friend made me go to the Dr. so it took forever to get that under control, and the Dr had me on antidepressant Zoloft as well as klonopin. but I quit the Zoloft cuz it made me have horrible and realistic nightmares and I didn't think I was actually depressed

Customer:

I didn't realize that I was actually depressed until two years ago, but I don't get why

Dr. Z :

Well for the panic attacks, I agree with you that the Gabapentin or the Klonopin (or other benzodiazpeines like Ativan and Xanax) are very effective at treating.

Customer:

are there other medications that are helpful?

Dr. Z :

Anxiety and Depression can occur simultaneously 65 percent of the time, so there is reason to believe that when you are very anxious, this can cause stress and make you depressed. Also if you are depressed, then that can cause you to feel anxious and stressed. So these two disorders are linked very often and is one reason why they co-occur.

Customer:

and what about for add treatment? I sometimes feel like the adderall has stopped helping

Dr. Z :

Typically for the panic attacks, a beta blocker may be helpful too

Dr. Z :

Well it is hard to tell if the Adderall is not working well for you or is it because of your increased anxiety that makes it appear that way because anxiety/depression, and PTSD can cause difficulty concentrating and focusing too

Customer:

like proponolol?

Dr. Z :

Yes Proponolol is one

Customer:

well so you are saying that I need to first treat the other problems before I can treat the add

Customer:

I'm never gonna be able to get back in school now am i

Customer:

or work a decent job

Customer:

I feel disabled

Dr. Z :

I think treating the other mental health issues will be the right approach for you before treating the ADD because like you said you have gone through so many medication changes and sometimes changing medications so much can cause more problems then good.

Customer:

I agree with that.

Dr. Z :

No I think you will be able to go back to school and get a decent job, but it will take time to find the right treatment for you, but the right treatment is out there

Dr. Z :

The important thing is that you cannot give up on this and keep trying new options for you like going to that specialist facility

Customer:

I sure hope so. what about electric shock therapy

Dr. Z :

Well I would recommend the Transcranial Magnetic Stimulation before electric shock therapy as there are less risk of side effects

Dr. Z :

But Electroconvulsive Therapy has been improved upon in the last few decades and it is very safe and may be beneficial for you too

Customer:

I'm muuuuch improved now than I was. I had stopped eating and sleeping and was abusing painkillers to numb myself. I had extreme rage and mood swings and hurt a lot of people. two months of my life are gone from my memory completely.

Dr. Z :

I am so sorry that must have been very distressing for you, but it is good that you are more improved now

Customer:

thank you so much. I am going to look into the transcranial and electroconvulsive therapies as well as talk to my therapist about doing the edmr next time. I am going to call my psychiatrist first thing in the morning, because I do NOT want to relapse

Customer:

or regress or whatever it is called.

Dr. Z :

I think that sounds like a good plan of action

Dr. Z :

I hope that it works out well for you and that these symptoms start to go away soon for you. My goal is to provide you with excellent service, so if you ever have any further questions or concerns please do not hesitate to contact me at anytime.

Customer:

one more thing sorry, my mother and father understand that I have these conditions

Dr. Z :

No problem ask away

Customer:

and they accept that it is taking some time and are being helpful and supportive and patient. but my mom always asks questions about things because she does not understand the conditions themselves.

Customer:

and she pulled something out of me the other day that I was nowhere near ready to talk to her about.

Customer:

what can I do or tell her so she stops blaming herself and can get a better idea of what goes on in my head? its impossible to explain

Customer:

and since she found the thing out, how do I deal with it

Customer:

if that makes sense?

Dr. Z :

Well have your mother read about PTSD a little bit or have her consult with a therapist to understand. But you and her have to discuss that there are going to be some things that you are not comfortable talking about and that you both should agree on a safe word that would allow you to put a stop to any particular topic of conversations with no questions asked.

Dr. Z :

I think for her she may need therapy herself to help her understand and deal with this in her own way and not rely on you to help her realize that she should not blame herself

Dr. Z :

Now that she knows this thing that she pulled out of you, for you to deal with it is that you have to take control of it and only deal with it when you are ready

Dr. Z :

If you are not ready to talk about it or deal with it the agree to her that you are not ready yet. Or if she is willing or live nearby maybe she can come to one of your therapy sessions where you may feel more comfortable discussing this matter and have your therapist better explain this issue to your mother

Dr. Z :

Any questions or concerns?

Customer:

well we already have family counseling sessions

Customer:

but we haven't focused much on understanding PTSD...more focus has been on things they can do to help me get better

Dr. Z :

Well maybe your mother needs to understand the process of PTSD and given a brief overview of it to help her

Customer:

maybe I will have her watch that No Kidding Me 2 movie. well, you've been extremely helpful, thank you very very much.

Dr. Z :

Anytime, I am always happy to help. I hope that your symptoms resolve swiftly for you

Customer:

I appreciate your time

Customer:

thank you

Dr. Z :

Let me know if you anything at all and please feel free to contact me at anytime

Dr. Z :

You are most welcome

Dr. Z :

Before you sign off though, I would very much appreciate if you could rate my performance in helping you so that I can get credit for this question. Thank you very much

I will tell you that...the things you have to go through to be an Expert are quite rigorous.

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